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Appendix

Slit-Skin Smears (or ‘Skin Scrapings’)

Slit-skin smears, also known as ‘skin scrapings’, are samples of dermal fluid obtained from several sites, smeared individually onto a glass microscope slide, and stained with the Fite stain, as described in the text. Examined microscopically under oil immersion (1000×) by a trained technician, the number of acid fast bacilli may be enumerated semi-quantitatively according to a six-point scale known as the Bacteriologic Index (BI) (35) as follows:

TABLE A1 Bacteriologic Index (BI)

Bacteriologic Index (BI) =

1

2

3

4

5

6

Number of bacilli /
number of oil-immersion fields

1/
100

1/
10

1/
1

10/
1

100/
1

>100/
1

Image

a

a

a

b

c

d

Representative oil-immersion fields for these different BI’s are shown in Figure A1.

FIG2_4_A1.png

Reliable, reproducible quantitation of the BI in slit skin smears is difficult and is performed optimally only by technicians experienced in obtaining, staining, and examining the smears

borderline lepromatous leprosy
erythema nodosum leprosum
multibacillary leprosy
paucibacillary leprosy
indeterminate leprosy
tuberculoid granuloma
lepromatous leprosy
tuberculoid leprosy
multi-drug therapy
reversal reaction
leprosy spectrum
bacterial index
slit-skin smear
neural leprosy
pure neural
Type 1
Type 2
ENL
MDT
ROM
BI
MB
LL
BT
BB
TT
BL
PB
RR